SPECT/CT as Gatekeeper for Extrathecal Administration on 99m Tc-DTPA Cisternography

Spontaneous intracranial hypotension is an entity caused by the loss of cerebrospinal fluid (CSF) volume. Cisternography presents an adequate diagnostic performance for the detection of CSF leaks. A 32-year-old woman with orthostatic headache of months of evolution, lumbar canal stenosis on magnetic resonance imaging and CSF hypotension suspicious of CSF leakage was referred to our department. Patient underwent 2 cisternographies: first was interpreted erroneously as CSF leakage being necessary procedure repetition and a retrospective review of SPECT/CT images for a correct diagnosis. This case illustrates the importance of checking the correct administration of the radiopharmaceutical with SPECT/CT for avoiding misdiagnosis.